Dr. Janet Patterson

The applicant sought a determination that he sustained a catastrophic impairment under Criterion 8 (mental or behavioural disorder) of the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found that the applicant's limitations in activities of daily living were predominantly caused by his physical impairments rather than a mental or behavioural disorder.

The applicant failed to establish a Class 4 (marked) impairment in activities of daily living, and thus could not meet the requirement of three Class 4 impairments.

Claims for various treatment plans were dismissed as the applicant's funding limits were exhausted.

However, the adjudicator granted an award of 25% under s. 10 of O. Reg. 664, finding that the respondent unreasonably delayed the payment of two invoices that it had previously agreed to pay.

The applicant sought various statutory accident benefits following a motor vehicle accident.

The respondent initially denied several treatment plans on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

After the applicant was removed from the MIG, the respondent failed to provide updated denial notices with medical reasons for several treatment plans.

The Tribunal applied the Divisional Court's decision in Suarez, holding that the defective notices could not be cured, and ordered those treatment plans payable once incurred.

The Tribunal also evaluated the substantive reasonableness and necessity of the remaining treatment plans, granting entitlement to psychological and occupational therapy based on the applicant's exacerbated pre-existing conditions, while denying further physical therapy and neurological assessments.

The claim for a special award was dismissed as the insurer's reliance on its assessors was not unreasonable.